Background: Brain metastasis from renal cell carcinoma (RCC) occurs approximately 8% of patients with metastatic RCC. The guidelines from the NCCN, EAU, and AUA recommendcerebral imaging only in patients who have symptomatology. The purpose of our study was to review the presenting symptomatology that led to their diagnosis of brain metastases followed by their overall treatment and survival. Methods: Our IRB-approved prospectively-maintained kidney cancer data base was reviewed between from 1995 to 2012. Brain metastases from a primary RCC was identified in 52 patients. Patient demographics including family and social history, primary treatment for RCC, elapsed time between primary diagnosis and brain metastasis, associated symptomatology, treatment of metastatic site and overall survival following diagnosis of brain metastasis were examined. Results: Primary RCC was diagnosed in 986 patients between 1995 and 2012. Brain metastases were identified in 52 patients, 79% were male and 100% Caucasian, 87% had no family history of renal malignancy. Primary treatment for RCC included 75% radical nephrectomy, 10% observation, 7.6% cytoreductive nephrectomy, 5.4% sunitinib, 2% interleukin-2 treatment. Central nervous system (CNS) symptoms were absent in 37% of patients diagnosed with brain metastases, while 73% presented with symptoms. The average number of metastases was 1.78 per patient in the asymptomatic group, and 2.7 metastases in patients with CNS symptoms (p=.18). Elapsed time from primary RCC treatment to diagnosis of brain metastases was an average of 730 days in the asymptomatic group and 1170 days for the symptomatic group (p=0.02). The symptomatic group has overall survival (OS) at one year of 81% and 69% at three years, while the asymptomatic group had an OS of 81% at one year and 31% at 3 years. Pulmonary involvement existed in 75% of both cohorts of patients (p=0.003). Conclusions: Our findings suggest that patients without CNS symptoms with brain metastases had a worse overall survival. The urologic guidelines recommending CNS imaging only in patients with symptoms may be missing a subset of the metastatic RCC population who could potentially benefit from early intervention, thus prolonging overall survival.