Brain damage is the destruction or degeneration of brain cells that can occur for a variety of reasons. Not all brain damage results in long term impairment or disability. However, it is almost always accompanied by varying degrees of changes in behavior, cognitive ability and emotional issues, some of which are long term and some of which will heal. Widespread brain damages can be the result of illness, such as meningitis; prolonged shortage of oxygen to the brain, such as would occur in near drowning; poisoning, including alcohol poisoning; and infections. Localized brain damage can also be the result of traumatic brain injury, stroke, aneurysm, neurological illness or heavy metal poisoning, including metal and lead. Both widespread and localized brain damage are traumatic to both the victim and to the family of the victim. Often there are drastic personality changes, speech and movement problems, and other mental handicaps. The management of brain damage is dependent on the extent of the damage and to what extent the injured individual is able to assist in their care. Many brain damages result in coma or vegetative states that leave the individual in need of constant care and therapy. Many of these people live in residential care centers where they can receive care around the clock.