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Periventricular Leukomalacia (PVL) is the most frequent brain injury to be associated with Cerebral Palsy (CP), especially in preterm infants. Spastic diplegia, a movement disorder commonly seen in CP, is characterized by increased muscle tone and spasticity in the lower extremities. The authors present a case of a 2-year-old child with mild PVL and spastic diplegia CP, with identifying factors including preterm birth history, his present age, and increasing severity of symptoms overtime. Magnetic resonance imaging was significant for an abnormally increased periventricular signal consistent with mild PVL. Due to worsening symptoms of toe-walking, increased gait width, and spasticity of lower extremities, interventions were recommended. This case demonstrates the neurodevelopmental consequences of PVL and ischemic brain injury in a preterm infant, resulting in spastic diplegic CP. A comprehensive and up-to-date review of the literature on PVL and spastic diplegia associated with CP is explored. Keywords: Cerebral palsy; Preterm; Spasticity; Hypoxic-ischemic encephalopathy; Magnetic resonance imaging.