In testimony Tuesday, Dr. Rogalska says VanderHeyden was alive at the time of both injuries.
"I can't say which one of those happened first and which one was the final one, and therefore, that's why they're both listed, each one of them, as fatal in this environment," Dr. Rogalska said.
Dr. Rogalska said the autopsy doesn't show who caused the fatal injuries. She also detailed other injuries and noted some of them are defensive in nature - like the ones on VanderHeyden's hands and feet.
Despite more than 240 injuries on her body, a medical examiner says she's narrowed down what killed Nicole VanderHeyden to two options.
"Ligature strangulation, and blunt force injuries to the head," Dr. Agnieszka Rogalska said.
"The fact that she has injuries on her wrists and on her ankles are also concerning, because those are areas where you try to control the limbs, so those are consistent with defensive injuries," Dr. Rogalska said.
After hearing about VanderHeyden's death we then learned more about her life. Friends and family described Nicole to the jury.
"She was very active," Nicole's sister, Heather Meyer, said. "She loved to rollerblade. She loved to take the kids out to the parks."
"She just was a light," friend Dallas Kennedy said. "She was always smiling."
Friends and family then described when VanderHeyden went missing. That night, Dallas Kennedy went to babysit VanderHeyden's young boy. VanderHeyden's boyfriend, Doug Detrie, came home with a friend but not Nicole.
"We proceeded to go over a few- just where could she be, just talking about what happened, where is she," Kennedy said.
The next day VanderHeyden's sister, Heather, went to Detrie's house. She said the two planned to go looking for VanderHeyden when they learned a body had been found.