What is the most likely diagnosis for a 65-year-old woman with sudden gait unsteadiness, vomiting, headache, and increasing drowsiness?

The scenario describes a 65-year-old woman presenting with sudden gait unsteadiness, vomiting, headache, and increasing drowsiness. The combination of these symptoms, particularly the sudden onset of gait instability and the neurological decline suggested by increasing drowsiness, strongly points towards acute cerebellar hemorrhage as a likely diagnosis.

Acute cerebellar hemorrhage typically presents with neurological deficits due to the involvement of the cerebellum, which is crucial for coordinating movement and balance. Symptoms can include ataxia (unsteady gait), nausea or vomiting (often due to increased intracranial pressure or irritation of the brain), and altered consciousness. The sudden nature of the symptoms and the age of the patient further support this diagnosis, as older adults are at a higher risk for such cerebrovascular events.

While acute subdural hemorrhage may also lead to similar symptoms, the acute presentation here more closely aligns with cerebellar hemorrhage, which can occur rapidly following a fall or trauma, leading to quick onset of symptoms. Frontal subdural empyema, on the other hand, typically has a more insidious onset and presents with signs of infection or increased intracranial pressure, making it less likely in this acute setting. Herpes