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Bow-and-Lean Test (BLT) is an important upright assessment test in patients with suspected horizontal semicircular canal BPPV.
Lean Positioning - initially did not elicit any nystagmus but on repeating the test after Bow positioning elicited horizontal nystagmus directed to the patient's left.
Bow Positioning: elicited horizontal positional nystagmus directed to the patient's right.
In the geotropic variant of horizontal semicircular canal BPPV, the lean nystagmus is directed to the non-involved (healthy) side, and Bow nystagmus is directed to the involved (diseased) side while in the apogeotropic variant of horizontal semicircular canal BPPV, the opposite holds true.