Background. Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of positional vertigo and usually responds well to canalith repositioning maneuvers. Atypical clinical features should raise suspicion for central nervous system pathology. Case presentation. We present a 64-year-old male with recurrent positional vertigo initially diagnosed as posterior canal BPPV. Dix–Hallpike testing elicited transient torsional geotropic nystagmus, and symptoms initially resolved after an Epley maneuver. One month later, vertigo recurred, and repeated repositioning maneuvers resulted only in partial improvement. Cranial magnetic resonance imaging revealed a posterior fossa intracranial lesion. The patient underwent neurosurgical treatment and was symptom-free at follow-up. Conclusion. Early recurrence and incomplete response to repositioning.