Purpose: Ruptured intracranial aneurysms has been occasionally reported as a cause of traumatic subarachnoid hemorrhage (TSAH). SAH due to rupture of the intracranial aneurysm is an important differential diagnosis in the TSAH. Our study was aimed to assess whether a rupture in a intracranial aneurysm could be predicted on the basis of the patterns of SAH on initial computed tomography (CT) in patients with the TSAH. Methods: 209 patients with the TSAH were retrospectively studied between the years 2003 and 2012. We examined the age and sex of patients, mechanisms of injury, Glasgow Coma Scale at admission, and CT parameters including the distribution and quantity of SAH, localized blood clot, intraventricular hemorrhage (IVH), or associated intraparenchymal hematoma (IPH). We compared non-aneurysmal group to aneurysmal group. Results: Forty-four (21.1%) patients with the TSAH harbored the ruptured intracranial aneurysms. The ruptured aneurysms were found in patients with diffuse or anteriorly located blood in basal cisterns (37.5%) and lateral sylvian fissure (8.2%), associated IPH (36.6%), and localized clot in subarchnoid space (100%). But the ruptured aneurysm was not found in all patients with perimesencephalic hemorrhage, convexities, bilateral sylvian fissure, or IVH. TSAH in the basal cisterns (OR=1.600, p=0.000) or sylvian fissure (OR=1.080, p=0.041), associated IPH (OR=1.577, p=0.000), or localized clots in the subarachnoid space (p=0.000) was significantly associated with the ruptured intracranial aneurysm in logistic regression analysis. Conclusion: Patterns of distribution of the SAH, the associated IPH, and the localized clots in the subarachnoid space on the initial CT scans could be predicted the ruptured intracranial aneurysm in the TSAH.