A stone was discovered lodged in Natasha McShane's throat after she was rushed to hospital following a random street assault in Chicago, a court has heard.
The Cook County Criminal Court was hearing from the trauma surgeon in the emergency room of Illinois Masonic hospital when Natasha and her friend Stacy Jurich were first admitted.
And Ms McShane's injuries were so serious that a brain surgeon was immediately told of her admission.
Surgeon Dr Marius Katilius said Ms McShane suffered a traumatic brain injury, with blood inside and outside the skull.
Three separate lacerations were discovered. There was blood in her hair, on her scalp and face.
There was "a lot of blood", Dr Katilius said and that a scan showed "an opaque structure in the back of the throat" and that the medical team "pulled out a stone from the back of the throat".
The attempted murder trial of Heriberto Viramontes (below) earlier heard dramatic evidence from Stacy Jurich, who also suffered serious injuries.
In testimony, Natasha's friend described the moment she was hit. "I heard my head being hit and I felt an excruciating pain and sort of lost my equilibrium," she told the court.
"Stupid bitch," her attacker whispered as he snatched her purse and ran.
Jurich said she never saw a face as all her attention was directed towards her friend: "She was not moving on the ground. The blood started coming out of her head."
Viramontes (34) is charged with two counts of attempted murder and 23 other charges linked to his alleged involvement in the April 23, 2010 attack.
Natasha's family watched as items of clothing found at the crime scene were pulled from a brown paper evidence bag yesterday in court.
Images of the scene, with McShane's cream jacket entwined in an olive green sweater beside pools of blood, were also shown. A police evidence technician was giving testimony on what she found at the scene.
Later, images of the accused Heriberto Viramontes at a petrol station were shown. Prosecutors allege he tried to use Stacy Jurich's credit card at the station less than half an hour after the two young women were attacked.
Apart from Jurich, the trial has also heard testimony from Sheila McShane, Natasha McShane's mother, who described how her daughter is severely disabled, unable to walk without support, incapable of conversation and barely able to communicate.
The jury saw video footage of Miss McShane as she was helped to walk and of her struggling to pick and drink from a cup of tea.
Mrs McShane also revealed the toll it has taken on her own life, with the strain partly leading to separation from her husband.
Natasha was described as an artistic, lively young woman, who was smart and had been always talking before the attack. Now, there is no conversation and her drawings end in scribbles.
Natasha's vision and balance have been so badly impaired she "skims off to the right" if allowed to walk on her own. In the video shown in court, Natasha is even wearing a helmet.
Mrs McShane said: "We do not have conversations... as a mother I can understand what's she's trying to tell me. She does not speak."
Mrs McShane explained how her daughter was making progress after returning to Ireland in the summer of 2010 but a seizure had left her in a wheelchair and infections weakened her further.
South Armagh woman Natasha McShane was going home through a Chicago viaduct after a night out with her friend Stacy Jurich when the two were set upon.
The Silverbridge girl was celebrating an internship to extend her stay in the US.
Ms Jurich's injuries were less severe and she returned to work. Natasha is paralysed and brain damaged.