Anterior semicircular canal Benign Paroxysmal Positional Vertigo (antBPPV) is the rarest form of semicircular canalolithiasis, corresponding to about 1-2 % of the BPPV. The diagnosis is obtained by either the Dix-Hallpike maneuver or the straight head hanging positioning maneuver, which provoke a characteristic positional down-beating nystagmus. This vertical nystagmus can be associated with a torsional component that helps in localizing the affected side. The differential diagnosis of antBPPV includes the various central lesions that produce vertical down beating nystagmus (posterior fossa). Several liberatory maneuvers have been proposed for the treatment of antBPPV, but still need standardization.