Pediatric spinal cord ischemia poses a diagnostic challenge due to its rarity and overlapping clinical features with other neurological conditions. Effective management requires the correct diagnosis among common differentials, including transverse myelitis, multiple sclerosis, and vascular malformations. In this study we present a unique case of spinal cord ischemia in a previously healthy 14-year-old male, occurred during Valsalva maneuver while playing the trumpet, marked by a cutaneous marker resembling livedo reticularis. The marker was localized precisely at the T12 vertebra, aligning with the position of the anterior spinal artery ischemia which we hypothesized was caused by the dilation of collateral veins at the level of the T12 cutaneous territory. Moreover, after excluding other causes of spinal cord ischemia, the T11 vertebral body ischemia, supported by radiological findings, raised suspicion for fibrocartilaginous embolism, which has been linked previously in other cases of Valsalva maneuver. All in all our case underscores the importance of a thorough approach to diagnosing and understanding causes of spinal cord ischemia, especially in previously healthy children with no cardiovascular, metabolic or genetic comorbidities. We believe that further research is required to elucidate the mechanisms linking cutaneous manifestations like livedo reticularis to spinal cord ischemia to facilitate the diagnostic and therapeutic process.