OBJECTIVES: Many survivors of cardiac arrest are left with considerable long-term impairments due to a transient ischemic state of the brain. Neuropsychologists identified a wide range of neuropsychological deficits in these patients besides the well-known amnesic syndrome. To date, there is no complete and unbiased documentation of the affected brain areas in vivo. We aimed to identify the brain tissue atrophy underlying the observed neuropsychological deficits in a case-control study. METHODS: We measured gray matter loss by voxel-based morphometry of 3-T structural magnetic resonance images in a sample of 12 patients who had had cardiac arrest with successful subsequent resuscitation in comparison with 12 individually age- and sex-matched control subjects. Such data are rare because many of these patients wear cardiac pacemakers. RESULTS: We found extensive reductions of gray matter volumes in the anterior, medial, and posterior cingulate cortex, the precuneus, the insular cortex, the posterior hippocampus, and the dorsomedial thalamus in tight correlation with neuropsychological impairments, namely, amnestic deficits and apathy. CONCLUSION: The identified neuroanatomical pattern of brain tissue loss substantiates the reports of wide-ranging neuropsychological impairments in patients after cardiac arrest.