A pathologist told the court she had a blood clot in her head that was between 10 and 14 days old when she died.
Dr Simon Stables said the clot was the result of trauma and led to brain swelling, which in turn caused Nia's brain to die.
He said blows to the head and falls from a height were usual causes of such injuries, which were common among boxers who received blows to the head and hit the ground.
Dr Stables performed an autopsy on Nia the day after she died and said "a substantial degree of force", possibly a kick, had caused the injury to her head.
He also found five bruises under her scalp but no fractures and no notable external injuries.
He ruled out natural causes, and said the type of injury to the toddler's head usually resulted in a quick decline in children, sending them into a coma in as little as 10 minutes.
"In essence, what this child has had is a huge stroke."
He said the symptoms of coma in a child Nia's age included appearing asleep, fits, incontinence, and frothing at the mouth - all of which earlier witnesses said were symptoms Nia displayed on July 21.
Dr Stables believed that Nia had received the head injury on July 20 because, from what he had been told, she had been acting relatively normally before then.
But under cross-examination, the pathologist acknowledged she could have been injured two days earlier when she was allegedly spun on a clothesline until she fell off and hit the ground.
Forensic neuropathologist Beth Synek dated the age of the head injury as "10 days plus".