Apogeotropic Posterior Canal BPPV Switches to Cupulolithiasis

Reverse Semont maneuver starting with face-down position to the patient's left was undertaken (Asprella, 2026), and the disorder was transformed into typical right posterior semicircular canalolithiasis during the face up position of reverse Semont maneuver. WE then completed the Semont maneuver during the ongoing reverse Semont maneuver to fix the transformed variant. Right and left Dix-Hallpike retests immediately after the Semont maneuver did not evoke any nystagmus.

After 24 hours, a right Dix-Hallpike retest evoked a persistent right torsional positional nystagmus that changed to left torsional downbeat on transitioning the patient to left lateral recumbent with nose down (positive inversion test). Bascule maneuver in the plane of left anterior-right posterior (LARP) plane was undertaken. Retesting after an hour in the right Dix-Hallpike position did not evoke any nystagmus, and the patient was symptom-free.

Telephone follow-up weekly for a month confirmed the patient remained free of positional vertigo.</p>