Initially, a right-sided half Dix-Hallpike test was performed, which elicited geotropic horizontal positional nystagmus. A subsequent left lateral head roll resulted in persistent right-beating (apogeotropic) horizontal positional nystagmus accompanied by a subtle downbeat component. Repeating the lateral head roll to the right then elicited left-beating (apogeotropic) horizontal positional nystagmus with a subtle superimposed upbeat component.