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Background: Detection of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) in patients with a poor clinical exam is challenging. Brain tissue oxygen tension monitoring (PbtO 2 ) and cerebral microdialysis (CMD) can detect ischemia and metabolic derangements. Our aim was to evaluate efficacy of these modalities in real-time detection of DCI., Methods: All patients with aSAH who underwent with multimodality monitoring (MMM) with PbtO 2 and/or CMD between the years of 2013 and 2015 at our institution were retrospectively studied. Mean PbTO 2 , lactate to pyruvate ratio (LPR), and glucose over the 24-h period prior to each angiogram for evaluation and treatment of vasospasm were correlated to the extent of vasospasm observed in the hemisphere with the monitors. The average measurements were also compared in the setting of presence and absence of angiographically significant vasospasm., Results: A total of ten patients with aSAH who underwent MMM were identified. PbtO 2 decline correlates with severity of proximal vasospasm (r = -0.66). PbtO 2 was significantly lower in the setting of vasospasm (17.6 vs. 25.8, p = 0.003), but LPR (34.5 vs. 26.8, p = 0.1) and glucose (0.8 vs. 1.1, p = 0.6) were not significantly different., Conclusion: Proximal vasospasm after aSAH is associated with MMM indicator of tissue ischemia and/or metabolic derangement. PbtO 2 and CMD help in real-time detection and management of DCI.